The use of resuscitative endovascular balloon occlusion of the aorta in a case of suspected septic distributive shock : a case report

Abstract

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is mainly used in patients with major noncompressible torso hemorrhage and more recently as an adjunct in cardiopulmonary resuscitation to improve coronary and cerebral perfusion pressure during chest compressions. The use of partial REBOA as a resuscitative adjunct in distributive shock like septic or anaphylactic shock is not a current indication of its use. Nevertheless, the use of partial REBOA for the early incidence of profound distributive shock with the need for massive vasopressor support can be an option and a bridge to stabilize the patient until further treatment can be administered. We presented a case of a patient with intraoperative profound septic shock due to the release of inflammatory mediators from purulent osteomyelitis during marrow canal reaming. Due to massive vasodilatation refractory to vasopressor and fluid resuscitation, the patient needed a short period of mechanical chest compression. After REBOA placement in zone I with partial REBOA, the patient became stable, and the vasopressors could be decreased. Within the next hour, due to the use of volume resuscitation and antibiotics, the patient became more and more stable, and REBOA could slowly be deflated. With deflated REBOA still in place, the patient remained stable in the intensive care unit and infection remediation through amputation of both lower legs could be carried out on the same day. The patient was discharged home without a neurologic deficit 6 weeks later. In a situation in which fluid resuscitation and the use of vasopressor cannot stabilize the patient in distributive shock, partial REBOA might be an option to restore central perfusion until further measures can take effect. In the described case, partial REBOA proved to be effective and was able to bridge the time until definitive care was effectively undertaken.